Prozac (Fluoxetine)

What Is Prozac (Fluoxetine)?

Prozac is the brand name of fluoxetine, a prescription drug used to treat depression.

This antidepressant is in a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing the amount of serotonin in the brain.

In addition to depression, Prozac is used to treat obsessive-compulsive disorder (OCD), binge-eating and vomiting in people with moderate to severe bulimia, and panic disorder (with or without agoraphobia, the fear of open spaces).

Fluoxetine capsules and tablets sold under the brand name Sarafem are used to treat premenstrual dysphoric disorder (PMDD), a condition in which a woman has symptoms of depression, irritability, and tension before menstruation.

Eli Lilly and Company makes Prozac, which was approved by the Food and Drug Administration (FDA) in 1987.

The delayed release capsule Prozac Weekly is also made by Eli Lilly and Company.

Generic forms of fluoxetine, fluoxetine delayed-release capsules, and Sarafem are also available.

Prozac Warnings

Prozac and other antidepressants are required to carry a black-box warning due to the increased risk of suicide.

Prozac may increase suicidal thoughts or actions in children, teenagers, and young adults within the first several months of treatment or after a change in dose.

Call your doctor immediately if you have any unusual changes in behavior or mood while on Prozac, including:

Thoughts about suicide or dying or attempts to commit suicide

New or worsening depression or anxiety

Feeling very agitated or restless

Panic attacks

Difficulty sleeping

New or worse irritability

Being aggressive, angry, or violent

Acting on dangerous impulses

Extreme increase in activity and talking

Decrease need for sleep

Before taking Prozac, tell your doctor if you have a history of seizures, bipolar disorder, liver disease, heart problems, including heart rhythm problems, diabetes, glaucoma, or thoughts of suicide or attempted suicide.

You may not feel the full benefits of Prozac for 4 to 5 weeks or longer after starting the medication. Before stopping Prozac, talk to your doctor. Stopping suddenly can cause serious side effects. Your doctor will help you safely stop the medication.

Don't take Prozac or other forms of fluoxetine if you are allergic to fluoxetine or any of the inactive ingredients in the formulations. Cases of severe allergic reactions have been reported and could result in death.

If you are taking a monoamine oxidase inhibitor (MAOI) or if you took an MAOI in the past 14 days, then don't use Prozac. A dangerous drug interaction could occur that may result in death.

Wait at least 5 weeks after stopping Prozac before beginning treatment with an MAOI drug. MAOIs include Marplan, Nardil, Eldepryl, Emsam, Zelapar, or Parnate and others.

Don't take Prozac if you are taking pimozide (Orap), because a dangerous drug interaction involving irregular heartbeats could occur. Also, don't take Prozac if you are taking thioridazine, the antibiotic linezolid (Zyvox), or intravenous methylene blue.

Avoid operating heavy machinery, driving a motor vehicle, or performing other dangerous activities until you know how Prozac affects you. It can cause sleepiness and may worsen your ability to make decisions, think clearly, or react quickly.

Stopping Prozac suddenly can cause serious side effects.

There is limited information regarding the long-term effects of Prozac on the development and maturation of children and adolescents.

Talk to your child's doctor about monitoring your their height and weight when they are taking Prozac.

Prozac and Pregnancy

Prozac is in FDA Pregnancy Category C, which means that harm to a developing fetus is possible.

Before taking Prozac, tell your doctor if you are pregnant or plan to become pregnant. The benefits and risks of Prozac in the third trimester of pregnancy should be very closely evaluated.

Babies of mothers who have been exposed to the medication at this time have had various side effects.

Tell your doctor if you are breastfeeding your baby before taking Prozac, because the medication passes into breast milk. Taking Prozac while you are breastfeeding is not recommended.

Prozac and Weight Gain

Weight gain is a side effect of many antidepressants (and other drugs), including Prozac.

A 2014 study in the journal JAMA Psychiatry found that people taking Prozac and other SSRIs gained one to two pounds over the course of a year; weight gain varied, depending on the SSRI used.

Some other reports indicate that up to 25 percent of antidepressant users experience weight gains of more than 10 pounds. This may be due to increased appetite among people taking antidepressants.

Other users have reported weight loss while using Prozac, and more research is needed to determine how Prozac and other SSRIs may contribute to weight changes.

If you're concerned about weight gain or loss while taking Prozac, talk with your doctor.

Prozac for Dogs and Cats

Prozac is sometimes prescribed for dogs or cats under the care of a veterinarian.

The drug may be prescribed for behaviors such as tail chasing, constant licking, or other obsessive-compulsive behaviors.

Do not give your dog or cat Prozac - or any other medication - without first speaking with your pet's veterinarian. Use Prozac and all other drugs according to the instructions that your pet's veterinarian provides.

Prozac (Fluoxetine) Interactions

Certain drugs are known to interact with Prozac and may cause problems.

Always tell your doctor or pharmacist about any drugs you take, including other prescription drugs, over-the-counter drugs, and any vitamins, dietary supplements or herbal remedies you're taking.

Here's what to do about specific drug interactions:

Do not take Prozac if you are taking a monoamine oxidase inhibitor (MAOI) or if you took a MAOI in the past 14 days. A dangerous drug interaction could occur that may result in death. Wait at least 5 weeks after stopping Prozac before beginning treatment with an MAOI. MAOIs include Marplan, Nardil, selegiline (Eldepryl, Emsam, Zelapar), and Parnate and others.

Do not take Prozac if you are taking pimozide (Orap), because a dangerous drug interaction involving irregular heartbeats could occur.

Do not take Prozac if you are taking thioridazine, and wait at least 5 weeks after stopping Prozac before beginning treatment with thioridazine, because a dangerous drug interaction involving irregular heartbeats could occur.

Do not take Prozac if you are taking the antibiotic linezolid (Zyvox) or intravenous methylene blue.

Before taking Prozac, tell your doctor if you are using any of the following medications. Your doctor may not want you to take Prozac, may need to change the doses of your medications, or may need to monitor you carefully for side effects:

Medications that can make you drowsy or sleepy, such as sedatives, sleeping pills, and tranquilizers

Prozac FAQ

Q: Does Prozac cause weight gain? And how is weight affected when coming off Prozac?

A: In some people, Prozac helps to curb the appetite. You should have a good balanced diet when you are coming off this drug.

Q: Does Prozac cause weight gain? And how is weight affected when coming off Prozac?

A: Weight gain was reported as a frequent side effect of Prozac, occurring in more than 1 percent of people who take it. Talk with your doctor about an alternative to Prozac if you're concerned about weight gain.

Q: I am taking the generic brand of Prozac recently instead of the brand name due to affordability. My weight went up a few pounds. Is this possible?

A: Taking the generic form of Prozac should not cause a weight increase since all the active ingredients are the same and must meet the same FDA standards. Talk to your health care provider to make sure there are no other medical issues that may be causing the weight gain.

Q: Does Prozac cause weight gain? I exercise and eat very well, but can't seem to drop the weight.

A: Selective serotonin reuptake inhibitors (SSRIs), the class of drugs including Prozac (fluoxetine), has been associated with changes in weight. Patients should contact their healthcare provider for any changes in their medical condition, including unusual weight gain. For more specific information, consult your physician or healthcare provider. You may also find helpful information at http://www.everydayhealth.com/drugs/prozac

Q: Can lifelong use of 50 mg of Prozac daily cause cancer or any sort of blood or organic disease?

A: Prozac is one of the oldest antidepressants on the market today. With 20 years of prescribing and reporting of side effects, there are no known long-term adverse effects related to the medication.

Q: Can Prozac weekly give you chest pains and palpitations?

A: The prescribing information for Prozac weekly does list palpitations as a frequent side effect of the medication, occurring in 1 out of 100 patients. You should have a discussion with your physician about any type of chest pain you are experiencing.

Q: I'm currently taking Prozac 10 mg and I'm wondering if this could be impacting my weight, the swollenness/redness in my face?

A: According to the literature available for Prozac (fluoxetine), changes in weight were a reported side effect. The studies have shown that various types of dermatologic side effects were reported. If you are experiencing unusual or bothersome symptoms while taking Prozac (fluoxetine), you may want to speak to your health care provider to determine the cause. For additional information regarding Prozac (fluoxetine) you may want to visit our Web site: http://www.everydayhealth.com/drugs/prozac.

Q: Does Tikosyn interact with Prozac?

A: It is always important to be aware of the medications you take and possible drug interactions. According the the prescribing information, Tikosyn and Prozac can interact and cause potentially dangerous side effects. You may want to speak with your health care provider to discuss other treatment options. For additional information regarding Tikosyn or Prozac, you may want to visit our Web site, http://www.everydayhealth.com/drugs/tikosyn and http://www.everydayhealth.com/drugs/prozac.

Q: My teenage son is taking Prozac. What are the side effects and what are the risks of having his dosage increased every time he visits the doctor? The doctor has increased the dosage without regard for my concerns as a parent. My son is only 13 years old.

A: In some cases, a doctor will start a patient on a low dose of a medication such as Prozac. This may be done to minimize the chance of side effects, particularly in the early stages of treatment, and to try to find the lowest effective dose. The doctor will usually have the patient come in for follow-up visits to assess how the medication is working and how the patient is tolerating the medication. During these evaluations the doctor may decide to increase the dose. This strategy is sometimes referred to as "start low and go slow." It is an attempt to get the optimal effect from a medication Ã¢â‚¬â€ the greatest benefit with fewest risks.
Patients who are on Prozac should contact their doctor if they have any new or worsening symptoms such as mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if they feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or harming themselves. Some serious side effects of Prozac are seizures (convulsions); tremors; shivering; muscle stiffness or twitching; red, blistering, peeling skin; rash; problems with balance or coordination; and agitation, confusion, sweating, or fast heartbeat. Less serious side effects from Prozac are drowsiness, dizziness, weakness, runny nose, sore throat, headache, flu symptoms, nausea, diarrhea, changes in appetite, weight changes, decreased sex drive, impotence, difficulty having an orgasm, dry mouth, and increased sweating. You should report any side effects your son may be having from Prozac.

Q: Can you take Prozac with the diet pill Alli?

A: Alli is a weight loss drug that blocks the absorption of some fats people consume. Prozac is an antidepressant used to treat conditions of anxiety, depression, panic, and obsessive compulsive disorder. There are no known drug interactions between Alli and Prozac. Do not start or stop any new treatments without first consulting with your doctor.

Q: Does fluoxetine (Prozac) make you gain weight?

A: Weight changes are common side effects with the selective serotonin reuptake inhibitors (SSRIs), the class of drugs that includes Prozac (fluoxetine). There are a variety of medications in this class and some cause more weight gain than others. Switching agents may or may not help. Consult your healthcare provider about any unusual weight gain and to see if changing medications is appropriate based on your specific circumstances. Do not stop or change the amount of medication you take without talking to your healthcare provider first. You may also find helpful information at http://www.everydayhealth.com/drugs/prozac Sarah Lewis, PharmD

Q: I have been taking Prozac and Wellbutrin together for 2 years. Do I have to take them forever?

A: Both Prozac (fluoxetine) and Wellbutrin (bupropion) are antidepressants that are typically used to treat depression, although they can be used for other purposes. Your healthcare provider will periodically re-evaluate your progress on these medications to determine if they are still needed. Your healthcare provider is best able to help guide your treatment decisions based on your specific circumstances. Do not stop or change the amount of medication you take without talking to your healthcare provider first. You may also find helpful information at http://www.everydayhealth.com/drugs/prozac and http://www.everydayhealth.com/drugs/wellbutrin

Q: How long does it take for Prozac to get out of the body?

A: Prozac (fluoxetine) http://www.everydayhealth.com/drugs/prozac has a slow elimination. The rate of elimination depends on various factors including how long a patient has been on the medication, individual patient metabolism, etc. Prozac is broken down in the body to an active metabolite called norfluoxetine. Norfluoxetine can have a half life of 4-16 days depending on length of therapy of the medication. The half life is the amount of time it takes for one half of the drug to be eliminated from the body. This long half life can cause active drug substance to still be in the body for weeks after dosing is stopped.
Jennyfer Marisco, RPh

Q: Can Prozac cause hair loss?

A: Hair loss, also called alopecia, is a rare but possible side effect of Prozac (fluoxetine). It is always a good idea to check with oneâ€™s health care provider in matters like this. Here is a link to more Prozac information: http://www.everydayhealth.com/drugs/prozac.
Gregory Latham, RPh

Q: I recently discontinued use of Prozac under the direction of my doctor. One of the reasons that I discontinued the medication was due to dizziness and sweating during the night. When I discontinued the medication before, these symptoms seemed to disappear. This time, however, I am having hot flashes and flushing and am sweating and hot on and off during the day and night. I am 47 years old. Do you think my symptoms are from discontinuing the Prozac or the onset of perimenopause?

A: Because the first time you stopped the Prozac, the symptoms disappeared and because this time they didn't, it sounds as though this could be the start of menopause. You should discuss this with your health care provider so they can determine if this is the medical condition that is occurring and not a different one. I have included a site with more information for you. http://www.everydayhealth.com/womens-health/menopause/index.aspx Gerald R. Levy, RPh

Q: How young is too young to start taking Prozac?

A: There are approved Food and Drug Administration dosages for Prozac for children as young as age 7. Of course there is an added risk for young people who use Prozac. A black box warning is attached to Prozac and it basically states that there is in increased risk of suicide in children, adolescents and young adults who use this medication. As always, speak with your doctor and express your concerns before you take any new medication regimen. You want to feel comfortable about the medication that you are putting into your body. Megan Uehara, PharmD

Q: My daughter has depression. She took Prozac, but it made her feel apathetic. Is there another antidepressant that has fewer side effects?

A: Unfortunately, your question does not have a simple answer. Treatment with antidepressants is extremely patient-specific. Often it is based on trial and error to find the appropriate balance between desired therapeutic outcomes and unwanted side effects. If she is experiencing bothersome side effects, your daughter may want to contact her health care provider to discuss other treatment options. You may also find helpful information on Prozac at http://www.everydayhealth.com/drugs/prozac. Beth Isaac, PharmD

Q: I have depression and anxiety. I am highly stressed by staying home now for nearly three years with my kids who are 4 years old and 9 months old. Should i take 10 mg of Prozac or wait to see if it all goes away? I'm nervous it will make sex troublesome or cause serious side effects that I don't already have. I filled the prescription but haven't taken it for five days because I'm so nervous. What do you recommend?

A: I am curious to know how you came by the Prozac (fluoxetine). Is it something that was prescribed for you or for someone else? There are sexual side effects. However, 10 mg is a fairly low dosage and is not necessarily effective for all people. The biggest problem with Prozac is that its latency can be up to six weeks until an improvement can be noticed. I would contact a provider and have them suggest something that can take effect in shorter time span if they seem fit. Matt Curley, PharmD

Q: Can you tell me what the exact symptoms are for withdrawal of Prozac. Can you suffer waves in the brain every time your heart beats?

A: According to the package insert for Prozac, the following is a list of symptoms that can occur after discontinuation of Prozac. These symptoms include: dysphoric mood (feeling anxious, depressed or uneasy); irritability and agitation; dizziness; sensory disturbances, such as electric shock sensations; anxiety; confusion; headache; tiredness; insomnia (inability to sleep); emotional lability (excessive emotional reactions); and hypomania. This may not be a complete list of side effects from discontinuation and others may occur. Tell your doctor about any unusual or bothersome side effect. Kristen Dore, PharmD

Q: I am currently on 40 mg of Prozac. I still feel very depressed (although much less anxious). Do I have any hope of reducing depression on 60 mg or is the Prozac just not going to do it? Will all SSRIs be incompatible with me for depression if Prozac is?

A: You have many options available to you. The most important thing is to talk to your physician regarding your current treatment and dissatisfaction. Your physician may choose to increase your dosage. The maximum adult dosage of Prozac for treatment of depression is 80 mg per day. There are also numerous other medications available both in the same class as Prozac (SSRI) or in other classes of medication. As always, talk with your physician regarding your medications and do not change your dosage of the medication without talking to your physician first. Attached is a link to additional information provided by Everyday Health regarding how to find the right medication to treat depression: http://www.everydayhealth.com/depression/finding-the-right-depression-medication.aspx. Jen Marsico RPh

Q: Is Prozac really safe to take for a lifetime at 50 mg daily? I am male and 66. Is it safe with natural nutrient/supplement blood-thinners like fish oils, vitamin E, and others? The fact sheet says, "Proceed with caution with anything which affects platelet-action." Is it safe if you are also a heavy cocoa drinker in view of cocoa's relatively high content of tryptophan and monoamine oxidase inhibitor?

A: Your question regards if Prozac (fluoxetine) http://www.everydayhealth.com/drugs/prozac is safe to take for a lifetime at 50 mg per day. You also asked if it is safe to take with natural blood thinners and if you are a heavy cocoa drinker. According to Lexi-Comp, Prozac is dosed anywhere between 20 mg to 60 mg per day depending on the indication. The maximum amount that is recommended is 80 mg/day. Unfortunately, I can not say one way or the other if the medication will be safe to take for your entire lifetime. There are a lot of factors that play into this. I will say though that when evaluating taking a medication, the patient and the physician must take into consideration the benefits and the risks associated with the medication. If you begin experiencing adverse reactions from the medication or if it is not an effective treatment, then you and your physician may need to consider another therapy. According to Lexi-Comp, Prozac can interact with medications that thin the blood or have anti-platelet effects. Please talk to your health care provider to see if you should be on the fish oils and vitamin E while taking Prozac. According to Lexi-Comp, recommendation on management of this interaction if it is necessary for the patient to be on the combination is to closely monitor the patient for signs and symptoms of bleeding or excessive bruising. The therapy should be monitored by your physician. I understand your reasoning with concerns about cocoa and Prozac, but could not find any well-documented information regarding this. Lexi-Comp did not mention anything in the dietary considerations specific to cocoa and Prozac. However, there is mention that caffeine should be avoided while on the medication and sometimes cocoa contains caffeine. I did come across a research article that hypothesized that after a patient taking Prozac ate chocolate he developed a rash that may have been attributed to the patient being very sensitive to activity in the serotonergic system at the dermal and epidermo-dermal junctional area. As always, talk with your health care provider regarding questions you have about your medications and interactions between medications and supplements. Always talk with your health care provider before beginning to take over-the-counter supplements so that it can be determined if the supplement is appropriate for you. Jen Marsico RPh

Q: I have premenstrual dysphoric disorder (PMDD) and was taking Prozac. I experienced a 25 pounds weight gain in 18 months. I stopped taking it 4 weeks ago, but I feel like my metabolism has been affected by this. I am watching what I eat and working out, but the weight is just not coming off. Can metabolism be affected after stopping the medication?

A: According to the package insert for Prozac (fluoxetine), the drug has a long elimination half-live, which means that it takes a long time for the drug to be eliminated from your body. Even when dosing is stopped, active drug substance stays in the body for weeks. The amount depends on individual patient characteristics, previous dosing regimen, and length of previous therapy at the time the drug is stopped. Your basal metabolic rate is the amount of energy your body burns at rest. One effective way to influence metabolism is through exercise. For more information about metabolism, exercise and weight loss, please visit http://www.everydayhealth.com/weight/exercise.aspx and http://www.everydayhealth.com/weight/weight-loss.aspx and consult with your health care provider. You are encouraged to report any negative side effects of prescription drugs to your health care practitioner and the Food and Drug Administration (FDA) by visiting www.fda.gov/medwatch, or by calling 1-800-FDA-1088. Michelle McDermott, PharmD

Q: I was diagnosed with depression in January 2010, and my doctor put me on Prozac. I've read about Prozac's long-term weight gain as a major side effect of the drug. I am concerned because I have been struggling with an eating disorder for 5 years now and am considering weaning myself off of the drug if it will inevitably lead to weight gain. What do you advise?

A: The most widely used depression medications on the market are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs have become widely prescribed because their side effects are limited. However, they still do have some side effects. Weight gain can be a common side effect of both of these classes of drugs. However, patients may react differently to different medications within these classes. If side effects, like weight gain, occur and become an issue for you, it sometimes helps to switch medications. Make sure your health care provider is aware of your medical history, including the eating disorder. Consult your health care provider if weight gain occurs to see if switching medications is appropriate for you. Available SSRIs, which affect serotonin, include paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), escitalopram (Lexapro), and citalopram (Celexa); SNRIs, which affect serotonin and norepinephrine, include venlafaxine (Effexor), duloxetine (Cymbalta), and mirtazapine (Remeron). Do not stop or change the amount of medication you take without talking to your health care provider first. Suddenly stopping Prozac can lead to serious withdrawal side effects. Stopping Prozac should only be done under the supervision of a physician who can guide you in tapering the dose. You may also find helpful information at http://www.everydayhealth.com/depression/understanding.aspx. Sarah Lewis, PharmD

Q: What is the best way to stop taking Prozac 40 mg a day?

A: You would want to work with your physician to come up with a gradual tapering of the dose over time to discontinue this medication. An abrupt cessation of Prozac (fluoxetine) may cause a discontinuation syndrome including headache, lethargy, GI upset, insomnia, nightmares, dizziness, vertigo, tremor, agitation, anxiety, irritability, and confusion. You can also find helpful information on depression at http://www.everydayhealth.com/depression/understanding.aspx.

Q: Have you heard of Prozac being prescribed for menstrual migraines?

A: Although menstrual migraine is not an FDA-approved indication for Prozac (fluoxetine), it is sometimes prescribed for menstrual migraines. Prozac is approved for premenstrual dysphoric disorder (PMDD). Headaches are a symptom of PMDD. PMDD symptoms typically occur after the middle of a monthly cycle after ovulation and usually gets worse during the week before menses. Prozac can be an effective headache prevention between ovulation and menses. If migraines continue to break through even while on Prozac, the dose can be increased right before menstruation. Dosing will have to be determined by a doctor and it is always good to speak with your health care provider regarding any concerns that you may have. Megan Uehara, PharmD

Q: When I first started taking Prozac, I lost my appetite. Now it seems like I'm always starving. Could this possibly be the medication?

A: Weight loss is listed as a common reaction to or side effect from taking-Prozac (fluoxetine). Side effects can be patient specific. Check with your doctor before making any changes to your drugs or doses. Click on the following link for additional information: http://www.everydayhealth.com/depression/understanding.aspx.

Q: Does Prozac make you gain weight?

A: Prozac (fluoxetine) (http://www.everydayhealth.com/drugs/prozac) has reported adverse effects of weight issues. Anorexia (poor appetite) has been reported in 4 percent to 17 percent of patients studied during clinical trials. Weight loss has also been reported at 2 percent and increased appetite, weight gain and taste perversion have also been reported. Increases in appetite could be a factor in patients that notice weight gain while being on Prozac. However, please keep in mind that there are many causes for weight gain besides possible side effects from medications. As always, talk with your health care provider regarding questions you have about your medications and associated side effects. If you are trying to lose weight, the attached link will provide valuable information from Everyday Health regarding weight loss: http://www.everydayhealth.com/weight/calories.aspx. Jen Marsico, RPh

Q: My doctor increased my dosage of Prozac. Since then, I have been having trouble staying awake in the afternoon, especially after lunch. Could this extra Prozac be causing this?

A: You are probably correct on this one. One of the side effects of Prozac is drowsiness and so this may be what is causing you to be tired in the afternoon. For some people, this effect does go away after a period of time until the drug levels become more level in the body. If this is too bothersome for you, try speaking with your doctor to see if you can switch medications or if there is some other recommendation they may have. Megan Uehara, PharmD

Q: Will taking Prozac cause me to gain weight and be hungry all the time?

A: Prozac (fluoxetine) can have an affect on weight changes. If you see an abnormal changes in your weight then you should talk to your Health Care Provider. All the drugs in this class can have weight change side effects. Each one may affect each person differently. You should discuss this with your provider before taking.. For more information you can go to http://www.everydayhealth.com/drugs/prozac Gerald Levy,RPh

Q: Could taking Prozac cause me to have a delay in speaking or stutter at all?

A: Prozac (fluoxetine) does list a change in speech and stuttering as possible side effects. If you are experiencing this side effect, and it is not tolerable, you may want to consult your doctor to see if an alternative medication may be better for you. There are many antidepressants available, and some work better than others for people. If you would like more information on depression and medications, please visit our links at: http://www.everydayhealth.com/depression/understanding.aspx, and http://www.everydayhealth.com/drugs/. Patti Brown, PharmD

Q: Currently I take Prozac and Abilify. Then I take Centrum and sometimes fish oil and vitamin E oil. Is this a safe combination?

A: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, panic disorder and premenstrual dysphoric disorder. Abilify (aripiprazole) is an atypical antipsychotic and antidepressant used in the treatment of schizophrenia, bipolar disorder, and clinical depression. Generally speaking, drug interactions fall into three main categories: Drug-drug (i.e., prescription, over-the-counter, herbals, dietary supplements) interactions occur when two or more drugs react with each other. Drug-diet (food/drink) interactions result from drugs reacting with foods or drinks. Drug-disease interactions may occur when an existing medical condition makes certain drugs potentially harmful. With Abilify and Prozac, the concomitant use of two or more drugs that have the potential to depress CNS function (either as a therapeutic intention or a side effect) is often clinically appropriate. However, it is important to recognize that the risk of unwanted effects may increase with such use. It is important to monitor for additive CNS-depressant effects if two or more CNS depressants are concomitantly used. For more detailed information, consult with your physician or pharmacist for guidance based on your specific condition and current medications, particularly before taking any action. Shereen A. Gharbia, PharmD

Q: What is the difference between Prozac and Zoloft?

A: Prozac (fluoxetine) and Zoloft (sertraline) are both antidepressants classified in the selective serotonin reuptake inhibitor (SSRI) class. Prozac and Zoloft are approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, panic disorder and premenstrual dysphoric disorder. Evidence suggests that Zoloft (sertraline) may work better than Prozac (fluoxetine) for some subtypes of depression. Side effects common to both are nausea, ejaculation failure, insomnia, diarrhea, dry mouth, somnolence, dizziness, tremor and decreased libido. For any immediate concerns, consult your physician. Joseph Hall, RPh

Q: I am depressed, on Prozac now 4 weeks at 20 mg and 2 weeks at 40mg. How long for it to reach its potential?

A: Prozac (fluoextine) (http://www.everydayhealth.com/drugs/prozac) belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac affects the chemicals in the brain that become unbalanced and cause depression, anxiety, and obsessive compulsive symptoms. (http://www.everydayhealth.com/depression/understanding.aspx) Prozac may be taken with or without food and at anytime of the day. It may take at least 4 to 6 weeks for the medication to start working. Do not stop taking the Prozac abruptly without first talking to the doctor because this could cause unwanted side effects. Common side effects of Prozac include headache, nausea, insomnia, drowsiness, dry mouth, diarrhea. Kimberly Hotz, PharmD

Q: I have been taking 20mg of Prozac and now I am advised to take half that dosage of Zoloft. What mg of Zoloft is equal to 10 mg of Prozac?

A: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Prozac is FDA approved for use in major depressive disorder, bulimia nervosa, obsessive compulsive disorder, premenstrual dysphoric disorder, panic disorder and bipolar disorder. Zoloft (sertraline) is also a SSRI antidepressant. Zoloft is FDA approved for treatment of major depression, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder. The lowest dose of Prozac that is available in capsules is 10mg. The lowest dose of Zoloft that is available in tablets is 25mg. 10mg of Prozac would be roughly equivalent to 25mg of Zoloft. Laura Cable, PharmD

Q: How do I get off Prozac?

A: Prozac (fluoextine) (http://www.everydayhealth.com/drugs/prozac) belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac affects the chemicals in the brain that become unbalanced and cause depression, anxiety, and obsessive compulsive symptoms. (http://www.everydayhealth.com/depression/understanding.aspx) Prozac may be taken with or without food and at anytime of the day. It may take at least 4 to 6 weeks for the medication to start working. Do not stop taking the Prozac abruptly without first talking to the doctor because this could cause unwanted side effects. Common side effects of Prozac include headache, nausea, insomnia, drowsiness, dry mouth, diarrhea. Consult with your doctor about how to safely discontinue Prozac. When your doctor prescribes a new medication, be sure to discuss all your prescription medications and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals and herbals, as well as foods you eat. Always keep a current list of the drugs and supplements you take and review it with your healthcare providers and your pharmacist. If possible, use one pharmacy for all your prescriptions and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and advise you about drug interactions and side effects. For more specific information or if you have concerns about the Prozac not working effectively, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kimberly Hotz, PharmD

Q: I take Prozac and wonder if I can also take passion flower for stress and anxiety. Will there be an interaction between this and the Prozac?

A: There are reports that increased sedation or low blood pressure could result from taking passion flower along with antidepressants including Prozac. Talk to your doctor before taking any over-the-counter vitamins or supplements, since many of these could interact with the medication you're taking. For more information about Prozac, go to http://www.everydayhealth.com/drugs/prozac. Gerald S. Levy, RPh

Q: Would Prozac cause excess sweating and low blood sodium?

A: Prozac (fluoxetine) is classified as a selective serotonin reuptake inhibitor (SSRI). Prozac is approved for the treatment of depression, treatment of binge eating and vomiting in patients with bulimia nervosa, obsessive compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), panic disorder, and in combination with other medications for bipolar depression. According to medical references, diaphoresis is a possible side effect associated with the use of Prozac and has been reported in studied patients with an incidence of 2% to 8%. Diaphoresis is defined as excessive sweating. Hyponatremia is listed as a possible side effect of Prozac with an incidence less than 1%. Hyponatremia is defined as a condition where the sodium level in the blood is low. If you think that you are experiencing a side effect from your medication, talk to your physician. Do not stop taking or change the dose of the medication without first talking to your physician. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Excessive sweating can have various causes. Everyday Health provides a symptom checker regarding excessive sweating. Click here to access the symptom checker. Something to take into consideration is that low sodium can be caused by excessive sweating. Jen Marsico, RPh

Q: Does Prozac have any side effects? If yes, what is the alternative? Is it possible to take Prozac for my whole life, as being advised to?

A: All medications have potential side effects and everyone responds to medications differently. Although many side effects may be listed you may get one, several, or none of the listed side effects. Prozac (fluoxetine) is a selective serotonin reuptake inhibitor antidepressant used for the treatment of depression, eating disorders, premenstrual dysphoric disorder, and panic disorder. It is possible to take an antidepressant indefinitely. The most common side effects with Prozac are insomnia, heachache, drowsiness, nausea, and anorexia. Other side effects with Prozac include diarrhea, dry mouth, anxiety, and weakness. This is not a complete list of the side effects associated with Prozac. Laura Cable, PharmD

Q: Does Prozac cause weight gain?

A: Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Prozac (fluoxetine) is an SSRI which may lead to weight gain or loss. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Laura Cable, PharmD., BCPS

Q: I take many vitamins and a few prescriptions; and I tremble all the time. Do any of my medications (meloxicam, Prozac, trazodone, vitamin, folic acid, iron, calcium and cranberry pills) cause this?

A: Tremor is a possible side effect of both Prozac (fluoxetine) and Desyrel (trazodone). Fluoxetine can cause the following nervous system side effects: tremor, headache, anxiety, nervousness, insomnia, drowsiness, sedation, dizziness, jitteriness, and fatigue. The most common side effects of trazodone are: tremor, blurred vision, constipation, decreased appetite, drowsiness, dizziness, dry mouth, headache, light-headedness, muscle aches, nausea, nervousness, and sleeplessness. This is not a complete list of the side effects associated with fluoxetine and trazodone. For more specific information, consult with your doctor or pharmacist Trazodone and fluoxetine can also cause serotonin syndrome, which can be a life-threatening condition. This is rare, but it is more likely when these medications are used together. Symptoms of serotonin syndrome include: sudden muscular contraction, tremor, rigidity, the inability to coordinate movements, irritability, altered consciousness, increased heart rate, hyperthermia, excessive sweating, shivering, abdominal cramping, nausea, vomiting, and diarrhea. You should consult your physician regarding the risks of taking trazodone and fluoxetine together verses the benefits of this combination. The following medications can also increasing the risk of serotonin syndrome: chlorpheniramine, cyclobenzaprine (Flexeril), dextromethorphan (Robitussin DM, etc), meperidine (Demerol), methadone, pentazocine (Talwin), sibutramine (Meridia), St. John's Wort (Hypericum perforatum), tramadol (Ultram), and tricyclic antidepressants. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat. Always keep a current list of the drugs and supplements you take and review it with your healthcare providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. Burton Dunaway, PharmD

Q: I temporarily increased my dose of fluoxetine from 10 mg to 30 mg before having sex for the first time in 18 months to combat premature ejaculation. It worked great the first time I had sex with my girlfriend, but the second, 3rd and 4th times last weekend, I couldn't climax. Did I overdose on it? I'm back to 10 mg per day now, 2,500 miles from my girlfriend.

A: Prozac (fluoxetine) is a medication that is used to treat depression, anxiety or panic disorders. It is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs) and is commonly related to sexual disorders. The prescribing information on fluoxetine states that up to 11 percent of patients taking this medication experience a decrease in sex drive. This medication also causes ejaculation issues in up to 7 percent of patients taking fluoxetine. For more information on fluoxetine, click on this link: http://www.everydayhealth.com/drugs/fluoxetine There is no way to know if you will experience sexual side effects from a medication before taking it. Sometimes, a patient will not experience any issues until the dosage of a medication is raised. The usual course of action is to decrease the dosage or switch to another medication to try to alleviate the issue. The best thing to do is have a discussion with your physician about your side effects and he or she will be better enabled to help you resolve the problem. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Poulin, PharmD

Q: What are the side effects of Prozac?

A: Prozac (fluoxetine) is a medication that is used to treat depression, anxiety or panic disorders. It is in the family of medications called selective serotonin reuptake inhibitors (SSRIs). This medication works on a chemical in the brain called serotonin, which helps transmit signals from one nerve to another in the brain. When this chemical becomes unbalanced, it causes a variety of different conditions, like depression. This medication helps to balance out serotonin to near normal levels, helping to alleviate the symptoms you experience. For more information on Prozac, click on this link: http://www.everydayhealth.com/drugs/prozac The prescribing information for Prozac lists the following as the most common side effects of the medication: insomnia, nausea , weakness, diarrhea, headache, loss of appetite, dry mouth, nervousness, decreased sex drive, drowsiness. This is not a complete list of the side effects associated with Prozac. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat. Always keep a current list of the drugs and supplements you take and review it with your healthcare providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects. Tell your health-care provider about any negative side effects from prescription drugs. You can also report them to the U.S. Food and Drug Administration by visiting www.fda.gov/medwatch or by calling 1-800-FDA-1088. Lori Poulin, PharmD

Q: What are the side efects for Prozac?

A: Prozac (fluoxetine) is a medication that is used to treat depression, anxiety or panic disorders. It is in the class of medications called selective serotonin reuptake inhibitors (SSRIs) and work by balancing out the chemical serotonin in the brain that is causing the symptoms. The prescribing information on Prozac lists the following as common side effects of the medication: insomnia, nausea, weakness, headache, diarrhea, loss of appetite, dry mouth, drowsiness and sexual side effects. This is not a complete list of side effects, for more information click on this link: http://www.everydayhealth.com/drugs/prozac For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Lori Poulin, PharmD

Q: Can you tell me more about Prozac?

A: Prozac (fluoxetine) is used to treat depression or obsessive-compulsive disorder (OCD) in adults and children. It is also used to treat bulimia and panic disorder in adults. It may also be used for other conditions as determined by your doctor. Prozac is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to improve certain mood problems. All medicines may cause side effects, but many people have no, or minor, side effects with fluoxetine. The most common side effects of Prozac are drowsiness, dizziness, anxiety, abnormal dreams, decreased sexual desire or ability, diarrhea, dry mouth, flu-like symptoms, flushing, sweating, loss of appetite, nausea, and trouble sleeping. Some medicines may interact with fluoxetine. Tell your physician if you are taking any other medicines. Do not suddenly stop taking fluoxetine without checking with your doctor. Withdrawal symptoms such as mood changes, numbness or tingling of the skin, dizziness, confusion, headache, trouble sleeping, or unusual tiredness may occur. For more information visit the Everyday Health Depression Center at: www.everydayhealth.com/depression/understanding.aspx or to submit another question return to www.everydayhealth.com/drugs. Burton Dunaway, PharmD

Q: I recently read that medications can cause bad dreams. I take a low dose of Prozac every other day to help with a mild case of anxiety. Since my Mom passed away five years ago, I have had many upsetting dreams about her being sick. She had a terrible fall and I watched her die in ICU in the hospital. She and I were very close and while I manage my grief well, I still regularly feel sad and upset about what happened to my Mom. Any idea that the medication could be contributing to the bad dreams? I never used to have disturbing dreams. Any recommendations on what I might do to stop or at least minimize these terrible dreams?

A: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor agent prescribed for the treatment of depression, obsessive compulsive disorder, panic disorder and premenstrual dysphoric disorder. A search of the prescribing literature lists abnormal dreams as a common side effect and recommends that if this side effect becomes bothersome, medical intervention is recommended. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action.

Q: How does bourbon interact with Prozac? Can it cause excessive bruising?

A: Prozac (fluoxetine) is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac is used to treat depression, obsessive-compulsive disorder, certain eating disorders, and panic attacks. Prozac works by increasing the amount of serotonin in the brain. Serotonin is a natural chemical that assists in maintaining mental balance. Generally speaking, drug interactions fall into three main categories: Drug-drug (i.e., prescription, over-the-counter, herbals, dietary supplements) interactions occur when two or more drugs react with each other. Drug-diet (food/drink) interactions result from drugs reacting with foods or drinks. Drug-disease interactions may occur when an existing medical condition makes certain drugs potentially harmful. No significant interactions between Prozac and bourbon (specifically) were identified; however, this does not necessarily mean no interactions exist. However, according to Prozac

Q: I am one of the slow reactors to the benefits of Prozac. And I do drink coffee - maybe 6 cups a day. Can it interfere with Prozac taking effect?

A: Prozac (fluoxetine) is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac is used to treat depression, obsessive-compulsive disorder, certain eating disorders, and panic attacks. Prozac works by increasing the amount of serotonin in the brain. Serotonin is a natural chemical that assists in maintaining mental balance. According to Prozac

Q: Does Prozac cause weight gain?

A: Prozac (fluoxetine) is classified as a selective serotonin reuptake inhibitor (SSRI) antidepressant. Prozac is approved for the treatment of depression, binge-eating, and vomiting in patients with bulimia, obsessive compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), panic disorder and with other medication to treat bipolar disorder. According to medical references, weight gain is a possible reported side effect of Prozac. Increased appetite and weight loss are also listed side effects of the medication. These are not a complete list of side effects associated with the use of Prozac. Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss. Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use. Most prescription medications associated with changes in body weight affect the central nervous system. These include antidepressants like monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). Mood stabilizers (lithium, valproic acid), antipsychotics, and anticonvulsants have also been linked with weight gain. Other drugs that have been reported to cause weight gain include diabetes medications (insulin, sulfonylureas, and thiazolidinediones), antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors. If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jen Marsico, RPh

Q: Can Prozac cause dry skin?

A: Prozac (fluoxetine) is an antidepressant that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRIs affect chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms. Prozac is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Common side effects of Prozac include drowsiness, dizziness, nervousness, mild nausea, upset stomach, constipation, increased appetite, weight changes, insomnia, decreased sex drive, impotence, and dry mouth. A search of a drug database and the prescribing information for Prozac did not specifically list dry mouth as a possible side effect. This is not a complete list of the side effects associated with Prozac. Sarah Lewis, PharmD

Q: Can the antidepressant, Prozac or its generic equivalent, cause extreme fatigue? My family doctor says no, but now I want your opinion.

A: Prozac (fluoxetine) is classified as a selective serotonin reuptake inhibitor (SSRI) antidepressant medication. Prozac is approved for the treatment of depression, binge eating and vomiting in patients with bulimia nervosa, obsessive compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), panic disorder and for the treatment of certain patients with bipolar depression in combination with other medications. According to medical references, somnolence is a common reported side effect of studied patients taking Prozac. It has been reported in 5% to 17% of studied patients taking the medication. Somnolence is defined as drowsiness, a state of near sleep, a desire for sleep or sleeping for excessive periods of time. If you think that you are experiencing a possible side effect from your medication, talk to your physician. Do not stop taking or change the dose of your medication without first talking to your physician. Keep in mind that extreme fatigue can be caused by many other factors besides possible side effects of medications. Sleep issues can be associated with some of the medical conditions that Prozac is used to treat. By talking with your physician, the extreme fatigue can be properly diagnosed. Treatment options can be explored after the diagnosis has been made. Jen Marsico, RPh

Q: Will Prozac cause bloating, cramping and gas?

A: Prozac (fluoxetine) is an SSRI (selective serotonin reuptake inhibitor) which is used to treat depression, and bloating, cramping, and gas are not listed side effects. Common side effects from Prozac (fluoxetine) include drowsiness, dizziness, nervousness, insomnia, dry mouth, cold symptoms, such as stuffy nose, sneezing, and sore throat, increased appetite, weight gain, and decreased sex drive, impotence, or difficulty having and orgasm. You may want to discuss using Gas-X (simethicone) to help treat your symptoms, as it makes the gas bubble break down into many smaller sizes, which are easy to pass. This is not a complete list of the side effects associated with Prozac (fluoxetine). Patti Brown, PharmD

A: Prozac (fluoxetine) is classified as a selective serotonin reuptake inhibitor (SSRI) antidepressant. Prozac is approved for the treatment of depression, binge eating and vomiting in moderate to severe bulimia nervosa, obsessive compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), panic disorder and in combinations with other medications to treat bipolar depression. According to medical references, somnolence (drowsiness) is a possible side effect associated with the use of Prozac. Somnolence has been reported with an incidence of 5% to 17% of studied patients taking the medication. If you think that you are experiencing a side effect from your medication, talk with your physician. Do not stop taking or change the dose of your medication without first talking to your physician. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jen Marsico, RPh

Q: My doctor increased my Prozac from 40 mg daily to 60 mg. Since then, I have been having trouble staying awake in the afternoon, especially after lunch. Could the higher prozac dose be causing this?

A: One of the side effects of Prozac is drowsiness and so this may be what is causing you to be tired in the afternoon. For some people, this effect does go away after a period of time when the drug levels become more level in the body. If this is too bothersome for you, try speaking with your doctor to see if you can switch medications or if there is some other recommendation they may have. Megan Uehara, PharmD

Q: Would taking Prozac cause me to have a delay in speaking or studder?

A: According to the prescribing information available for Prozac (fluoxetine), change in speech and stuttering are reported as possible side effects. If you are experiencing this side effect, and it is not tolerable, you may want to consult your doctor to see if an alternative medication may be better for you. There are many antidepressants available, and some work better than others for people. For more information on depression: http://www.everydayhealth.com/depression/understanding.aspx Patti Brown, PharmD

Q: Does Prozac have any long-term health risks?

A: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, eating disorders, obsessive-compulsive disorder, premenstrual dysphoric disorder, and panic disorder. Many patients have been on Prozac for many years without adverse effects. Prozac is considered safe to use long term if needed. Warnings from the prescribing information for Prozac include the following. Prozac like all antidepressants can increase the risk of suicidal thinking and behavior in children and young adults, especially when the medication is first started. Prozac may worsen psychosis in some patients or cause mania in patients with bipolar disorder. Prozac should be used with caution in patients with seizure disorders, liver or kidney disease, and history of heart disease. Prozac may cause weight changes, sleep changes, and sexual dysfunction. Patients who have been on Prozac long term and wish to stop the medication will need to taper the dose down to prevent withdrawal symptoms. This is not a complete list of the side effects associated with Prozac. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat. Always keep a current list of the drugs and supplements you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects.
Laura Cable, Pharm.D., BCPS

Q: My daughter takes Prozac and she doesn't swallow the pills, so I open up the capsule and put it in pudding. Is that making any difference in the medication?

A: I could find nothing saying that Prozac causes any problems being used the way you described. I would recommend she swallow the pudding and not chew it. Prozac is also available in a 20 mg/teaspoonful liquid both in brand name and generic. I don't know if this would be any easier for her or not but it is always an option.

A: There is no indication that Prozac (fluoxetine) would cause this symptom. If this condition persists, please see your physician or dermatologist. Joseph Hall, RPh

Q: Can being on Prozac make you loss your sexual drive?

A: Unfortunately, a common side effect of Prozac (the generic is fluoxetine) and other SSRIs (selective seratonin reuptake inhibitors) like it is a decrease in sex drive. Depression can also decrease sex drive. To help with this, it's recommended that you take your regular dose after the time you would normally expect to have sex. This gives more time until the next time you want to have sex, and the drug should cause less of the side effect by then. Your doctor could also prescribe a medication to help with a low sex drive. And you could talk to your doctor about taking a "drug holiday," scheduling a day or two off of the drug each week. If none of these options work, you may need to try a different antidepressant. Always discuss the options with your doctor first to see what would be the best choice for you. For more information on depression, go to http://www.everydayhealth.com/depression/understanding.aspx. Patti Brown, PharmD

Q: What are the possible Prozac withdrawal symptoms?

A: There are possible Prozac (fluoxetine) withdrawal symptoms which may be associated with abrupt discontinuation of the medication. According to the prescribing information for Prozac, during marketing of Prozac, serotonin norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs), there were spontaneous reports of withdrawal symptoms which occurred upon discontinuation of these medications, particularly when discontinuation was abrupt. Possible Prozac withdrawal symptoms may include dysphoric mood, irritability, agitation, dizziness, sensory disturbances, such electric shock sensations, anxiety, confusion, headache, lethargy, excessive emotional reactions and frequent mood changes, insomnia and hypomania. Marketing research indicated that most of these reactions were typically self-limiting and did not require treatment. However, there were reports of serious symptoms associated with discontinuation. Patients are advised against abrupt discontinuation of Prozac. Patients are also advised to take Prozac exactly as prescribed and should not alter the dosing regimen or discontinue treatment with Prozac without consulting their health care provider.
Patients should be appropriately monitored, by their health care provider, for these symptoms during the discontinuation period. To avoid the possible Prozac withdrawal symptoms, it is recommended for patients to gradually reduce the dosage of Prozac rather than abruptly discontinue treatment. An appropriate tapering period which implements a gradual dosage reduction should be under the supervision of a health care provider.
As a result of the long elimination half-lives of Prozac and its active metabolite, norfluoxetine, concentrations in the blood gradually decrease upon appropriate discontinuation of treatment which minimizes the risk for developing the possible Prozac withdrawal symptoms. Typically, even when treatment has been discontinued, active drug substances remain in the body for weeks, depending on patient specific characteristics, as well as previous dosing regimen and length of treatment.

Q: What is the recommended Prozac dosage?

A: The recommended Prozac (fluoxetine) dosage depends upon the indication for treatment. Prozac is a selective serotonin reuptake inhibitor (SSRI) antidepressant indicated for major depressive disorder, obsessive-compulsive disorder, bulimia and panic disorder, with or without agoraphobia.
For the treatment of major depressive disorder in adults, the initial Prozac dosage is 20 mg per day administered in the morning. The usual recommended Prozac dosages range from 20 to 80 mg per day. According to clinical studies, 20 mg per day is typically an adequate Prozac dosage to achieve a satisfactory therapeutic response in most cases of major depressive disorder. Dosages greater than 20 mg per day may be administered once daily in the morning or twice daily (morning and noon) if necessary. Maximum daily doses should not exceed 80 mg per day. Prozac has also been proven effective for once weekly administration.
For the treatment of major depressive disorder in the pediatric population, 8 years of age and older, the usual recommended Prozac dosage is 10 to 20 mg per day.
Treatment with Prozac for major depressive disorder may require four weeks or longer before the full pharmacologic effect is observed.
For the treatment of obsessive-compulsive disorder in adults, the initial Prozac dosage is 20 mg per day administered in the morning. The usual recommended Prozac dosages range from 20 to 60 mg per day. However, 80 mg per day dosages have been well tolerated in clinical studies. The maximum daily dose is 80 mg.
For the treatment of obsessive-compulsive disorder in adolescents and higher weight children, 7 years of age and older, the usual recommended Prozac dosage is 20 to 60 mg per day with an initial dosage of 10 mg per day. For lower weight children, 20 to 30 mg per day is recommended.
For the treatment of bulimia nervosa in adults, the usual recommended Prozac dosage is 60 mg per day administered in the morning. In some patients, dose titration over several days may be advisable.
For the treatment of panic disorder in adults, the initial Prozac dosage is 10 mg per day. According to the prescribing information, the dosage should be increased to 20 mg daily after one week of treatment. The usual recommended Prozac dosage is 20 mg per day administered in the morning. During clinical trials, patients were administered dosages ranging from 10 to 60 mg. A dosage of 20 mg was most frequently administered to patients during clinical trials.
For all indications of Prozac, it may require four weeks of treatment or longer before patients experience improvements in symptoms. It is essential for patients to continue with treatment exactly as directed to achieve desired therapeutic outcomes.

Q: What is the difference between generic and brand Prozac?

A: In most patients, there is no significant difference between generic and brand Prozac (fluoxetine). There is currently a generic equivalent available for Prozac, known as fluoxetine.
The U.S. Food and Drug Administration (FDA) requires that generic medications be bioequivalent to the brand-name medication and, therefore, exert the same pharmacologic effects in the body. Generic medications are considered, by the FDA, to be therapeutically identical to the brand-name counterparts in dose, strength, route of administration, safety, efficacy and indication for use. Generic medications will appear differently and may have different inactive ingredients, however, the labeling and directions for use remain the same.
For most medications, generic equivalents are a lower-cost alternative to the more expensive brand-name medication, and the majority of patients observe no changes in therapeutic effect. However, some patients may experience a change in therapeutic effect and, subsequently, must continue treatment with the brand-name medication.
Generic Prozac, fluoxetine, is a selective serotonin reuptake inhibitor (SSRI) antidepressant which is approved for the treatment of major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder and bulimia nervosa.
Frequently reported side effects for generic Prozac are similar those observed in patients being treated with the brand-name medication and may include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn.
The warnings and precautions associated with Prozac are also possible with the generic fluoxetine. According to the prescribing information for Prozac, warnings and precautions, possible with treatment, include clinical worsening of depression and suicide risk, serotonin syndrome or neuroleptic malignant syndrome-like reactions, allergic reactions and rash, activation of mania or hypomania, seizures, altered appetite and weight, abnormal bleeding, hyponatremia, possibility of anxiety and insomnia, potential for cognitive and motor impairment and long half-life affecting changes in dosage.
Fluoxetine, generic Prozac, should be administered exactly the same as the brand-name medication. Fluoxetine is typically taken once daily and administered in the morning.

Q: Is Prozac for insomnia?

A: Prozac (fluoxetine) is not indicated for insomnia treatment by the U.S. Food and Drug Administration (FDA). Prozac is approved by the FDA for the treatment of several other medical conditions including depression, obsessive-compulsive disorder, bulimia nervosa and panic disorder.
During clinical trials, one of the most commonly observed adverse reactions in patients being treated with Prozac, for any indication, was insomnia. During placebo-controlled clinical trials for major depressive disorder, Prozac caused insomnia in 16% of patients being evaluated. In trials evaluating Prozac for obsessive-compulsive disorder, 28% of patients reported insomnia as an adverse reaction associated with treatment. During the clinical trials of bulimia, 33% of patients reported experiencing insomnia caused by Prozac. Finally, in the clinical studies of patients with panic disorder, Prozac precipitated insomnia in 10% of patients. Overall, for all indications combined, the incidence of Prozac causing insomnia was reported by 19% of patients.
According to the prescribing information, insomnia was one of the most common adverse reactions associated with discontinuation of Prozac in patients with bulimia, with 2% of patients discontinuing treatment.
Patients should be advised to take Prozac exactly as directed by their health care provider. If patients experience unpleasant or bothersome adverse reactions, such as insomnia, they are also advised not to change their dosing regimen or discontinue treatment without consulting with their health care provider.

Q: What is Prozac?

A: Prozac (fluoxetine) is an antidepressant categorized as a selective serotonin reuptake inhibitor (SSRI). Prozac is approved, by the U.S. Food and Drug Administration (FDA) for the acute and maintenance treatment of major depressive disorder in adult and pediatric patients aged 8 to 18 years, the acute and maintenance treatment of obsessive-compulsive disorder in adult and pediatric patients aged 7 to 17 years, the acute and maintenance treatment of bulimia nervosa in adult patients and the acute treatment of panic disorder, with or without agoraphobia in adult patients. Prozac is typically administered in the morning and the recommended dosage depends on indication for use.
Prozac is available in a capsule formulation in 10 mg, 20 mg and 40 mg strengths. Prozac is also available in a capsule formulation for weekly administration in 90 mg strength.
The concomitant use of Prozac with a monoamine oxidase inihibitor (MAOI) is contraindicated. Do not use Prozac with an MAOI or within 14 days of discontinuing treatment with an MAOI to avoid a potentially dangerous drug interaction. At least five weeks should be allowed after discontinuation of Prozac treatment prior to initiation of treatment with an MAOI because of the long half-life of Prozac. Prozac is also contraindicated in patients being treated with pimozide and thioridazine because of dangerous drug interactions. Do not use thioridazine within five weeks of discontinuing Prozac treatment.
There are several warnings and precautions associated with Prozac treatment that patients should discuss in detail with their health care provider and understand fully prior to initiation of treatment. According to the prescribing information, the warnings and precautions, possible with Prozac treatment, include clinical worsening of depression and suicide risk, serotonin syndrome or neuroleptic malignant syndrome-like reactions, allergic reactions and rash, activation of mania or hypomania, seizures, altered appetite and weight, abnormal bleeding, hyponatremia, possibility of anxiety and insomnia, potential for cognitive and motor impairment and long half-life affecting changes in dosage.
The most commonly observed adverse reactions, reported in 5% or more of patients studied in clinical trials, included abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn.
Prozac is extensively metabolized (broken down) in the liver by the cytochrome P450 system and, therefore, has the potential to interact with several medications. It is essential for patients to inform their health care provider of all medications they are currently taking, including prescription medications, over the counter products and dietary or herbal supplements.
Treatment with Prozac, for all indications, may require four weeks of treatment or longer before patients experience improvements in symptoms. It is essential for patients to continue with treatment exactly as directed to achieve desired therapeutic outcomes.

Q: What are the benefits and risks of Prozac?

A: There are several benefits and risks of Prozac (fluoxetine). For most patients, the benefits outweigh the risks of treatment with Prozac. However, there are still various risks a patient should be aware of prior to initiation of therapy. The benefits of Prozac extend across many medical conditions. Prozac, a selective serotonin reuptake inhibitor (SSRI) antidepressant, is a proven effective treatment option and has demonstrated benefits in patients with major depressive disorder, obsessive-compulsive disorder, panic disorder and bulimia. In addition, Prozac has proven benefits for major depressive disorder and obsessive-compulsive disorder in the pediatric population as well.
There are no drug treatments that are not without risk, including Prozac. One of the risks of Prozac treatment is the commonly occurring side effects. The most commonly reported side effects in patients treated with Prozac include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn. The commonly observed side effects were reported by at least 5% of patients receiving Prozac in clinical trials.
Other risks of Prozac include several warnings and precautions which may occur with treatment. There is a risk of clinical worsening of depression symptoms and risk of suicide in both the adult and pediatric population. Clinical trials revealed that antidepressant drugs increase the risk of suicidality in children, adolescents and young adults ages 18 to 24 with major depressive disorder and other psychiatric disorders. According to the prescribing information, all patients being treated with antidepressants, including Prozac, for any indication should be closely monitored and observed for clinical worsening, suicidality and unusual changes in behavior, especially during the first few months of therapy or during times of dosage adjustments. Patients should be monitored for the following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathesia, hypomania and mania. These symptoms have been reported in adults and the pediatric population being treated with antidepressants for major depressive disorder, in addition to other psychiatric and nonpsychiatric indications.
It is important to advise patients taking Prozac to be aware of the risk for serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions that may occur with SSRIs alone or with the concomitant use of Prozac and other serotonergic medications, such as the triptans (medications used to treat migraine headaches), tramadol, serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine), Effexor (venlafaxine) or Pristiq (desvenlafaxine), or other SSRIs. Symptoms of serotonin syndrome or NMS-like reactions include agitation, confusion, increased heart rate and blood pressure, sweating, headache, diarrhea, loss of muscle coordination, and possibly fever and seizures. Seek immediate medical attention if you experience any of these signs and symptoms.
Prozac may cause an increased risk for bleeding. Patients taking Prozac should discuss the concomitant use of Prozac with non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, aspirin, warfarin or other medications that affect coagulation with their physician to avoid an increased risk for bleeding. Before taking any of these medications, it is important to consult with your physician and call your physician immediately if you experience any bleeding or bruising.
Hyponatremia (low levels of sodium in the blood) has been reported as a result of Prozac treatment. It is important to be aware of the signs and symptoms associated with hyponatremia so you can recognize them if they occur. Signs and symptoms include headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness, hallucination, passing out, seizure, coma, respiratory arrest and death.
Patients should discuss the benefits and risks of Prozac with their health care provider prior to initiation of treatment.

Q: What is the difference between Cymbalta versus Prozac?

A: There are a number of differences between Cymbalta (duloxetine) versus Prozac (fluoxetine). The main differences between Cymbalta versus Prozac include mechanism of action, the way in which the drug works in the body, and indications for use approved by the U.S. Food and Drug Administration (FDA). Cymbalta is a potent inhibitor of both serotonin and norepinephrine reuptake in the central nervous system, while Prozac is a much more potent inhibitor of serotonin reuptake than norepinephrine.
The only common indication between Cymbalta and Prozac is major depressive disorder. Cymbalta belongs to a class of antidepressants known as serotonin norepinephrine reuptake inhibitors (SNRI) and is indicated for the treatment of major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia and chronic musculoskeletal pain. Prozac belongs to a different class of antidepressants known as selective serotonin reuptake inhibitors (SSRI) and is indicated for the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder and bulimia nervosa.
Another difference between Cymbalta versus Prozac is approved use in the pediatric population. While Prozac is currently approved, by the FDA, for the treatment of major depressive disorder and obsessive-compulsive disorder in the pediatric population, both in children and adolescents, the safety and effectiveness of Cymbalta in the pediatric population has not been established.
Another difference between Cymbalta versus Prozac is there is currently no generic equivalent available for Cymbalta, while Prozac is available in a generic form, known as fluoxetine.
Cymbalta and Prozac have similar adverse reactions and warnings and precautions associated with treatment. However, Cymbalta has been associated with an increased risk of mydriasis (prolonged dilation of the pupils of the eye) and should be used cautiously in patients with controlled narrow-angle glaucoma. Patients should be advised to discuss with their health care provider if they have a past medical history of glaucoma prior to initiation of treatment with Cymbalta. Another difference between Cymbalta versus Prozac, with regard to warnings and precautions, Cymbalta treatment was observed to worsen glycemic control in some patients with diabetes during clinical trials.

Q: How do I take Prozac for depression?

A: To take Prozac (fluoxetine) for depression, patients should be advised that treatment may require four weeks or longer before the full therapeutic effect of Prozac is observed. It is essential for patients to take Prozac for depression exactly as prescribed by a health care provider and not to adjust the dosing regimen or discontinue treatment with Prozac without the supervision of their doctor.
Prozac is indicated for the treatment of depression in adult and pediatric patients, aged 8 to 18 years. To take Prozac for depression, the initial adult dose is 20 mg per day administered in the morning. The usual dosage of Prozac for depression ranges from 20 to 80 mg daily. During clinical trials for depression, 20 mg daily was an adequate dosage, in most patients, to achieve a desired therapeutic outcome. Research suggests that dosages higher than 20 mg per day may be administered once daily in the morning or may be administered twice daily when necessary, in the morning and at noon. To take Prozac for depression, the maximum daily dose is 80 mg. Prozac for weekly administration is also effective for treating depression in adults.
To take Prozac for depression in children and adolescents, age 8 and older, the usual dose of Prozac is 10 to 20 mg daily.
For both adult and pediatric patients, an increase in dosage of Prozac may be considered after several weeks of treatment if a less than satisfactory clinical improvement is observed. It is essential that patients are periodically monitored and reassessed to determine if further treatment is required.
When taking Prozac for depression, doses are typically administered in the morning unless otherwise instructed.
Patients taking Prozac for depression should be informed regarding the most commonly observed adverse reactions. During clinical trials, adverse reactions reported in 5% of patients or greater included abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia, diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, decreased libido, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation and yawn.
Prior to beginning treatment with Prozac for depression, it is essential to inform your physician of any other medications you are currently taking, including prescription medications, over the counter products and dietary or herbal supplements to avoid potentially dangerous interactions.

Q: How can I lose weight after Prozac?

A: In placebo-controlled clinical trials for major depressive disorder, obsessive-compulsive disorder and bulimia nervosa, altered appetite and weight after beginning Prozac treatment was reported. In clinical studies of Prozac for major depressive disorder, 11% of patients reported anorexia and 1.4% of patients reported weight loss. Similarly, in trials of Prozac for obsessive-compulsive disorder, 17% of patients reported anorexia and one patient discontinued treatment as a result. In studies evaluating Prozac for bulimia, 8% of patients reported anorexia and lost a minimal amount of weight. The incidence of patients experiencing weight loss for all indications of Prozac combined was 2%. Patients did not report weight gain or difficulty losing weight during clinical studies or postmarketing experience with Prozac.
Prozac is a potent inhibitor of neuronal serotonin reuptake in the central nervous system and therefore categorized as a selective serotonin reuptake inhibitor (SSRI). Prozac is used for the treatment of bulimia, panic disorder, obsessive-compulsive disorder and major depressive disorder.
The tools with which to lose weight after Prozac are the same as those for any other individual attempting to lose weight. In general, irrespective of drug therapy, the safest and most effective method for long-term weight loss is proper diet and exercise. Eating a healthy, well-balanced diet full of fruits, vegetables and whole grains while limiting sugar, processed foods and alcohol typically people lose weight.
According to the National Heart Lung and Blood Institute (NHLBI), a part of the National Institutes of Health (NIH), to lose weight it is essential for individuals to make lifestyle changes which focus on reducing calories from food and drink, a healthy eating plan and proper portion control. Furthermore, the NHLBI outlines a healthy eating plan to control portion sizes and include fruits, vegetables, whole grains and fat-free or low-fat dairy products. A healthy eating plan should also include lean meats, poultry, fish, beans, eggs and nuts and be low in saturated fat, trans fat, cholesterol, sodium and added sugars.
To safely and effectively lose weight, in general and after Prozac, individuals need to expend more calories than they take in. Essentially, individuals need to reduce their daily caloric intake from food and beverages and increase calories burned through physical exercise. An appropriate diet and exercise regimen should initially be under the guidance of a physician.

Q: How can I treat bipolar disorder with Prozac?

A: To treat bipolar disorder with Prozac (fluoxetine), another medication must be prescribed in combination. Prozac is not currently approved as monotherapy for the treatment of depressive episodes associated with bipolar disorder. The active ingredient in Prozac, fluoxetine, is available in combination with another medication, olanzapine, and is marketing under the name Symbyax (olanzapine/fluoxetine). Symbyax is approved by the U.S. Food and Drug Administration (FDA) for the acute treatment of depressive episodes associated with bipolar disorder in adults.
To treat bipolar disorder with Prozac in combination with olanzapine most physicians will prescribe combination Symbyax. The efficacy of Symbyax for the acute treatment of depressive episodes associated with bipolar disorder was established in controlled studies. Symbyax should be administered once daily in the evening. To treat depressive episodes associated with bipolar disorder with Symbyax, treatment is typically initiated with the 6 mg/25 mg strength capsules. While both Prozac and olanzapine individually can be administered without regard to meals, the effect of food on Symbyax specifically has not been evaluated. According to the prescribing information for Symbyax, dosage changes should be assessed according to efficacy and patient tolerability. The ideal duration of treatment with Symbyax is unknown and patients should be periodically reassessed by a health care provider to determine if continued treatment is necessary.
The most common adverse reactions observed during clinical trials, reported by 5% or more of patients being treated with Symbyax, included disturbance in attention, dry mouth, fatigue, hypersomnia, increased appetite, peripheral edema, sedation, somnolence, tremor, blurred vision and increased weight.
Patients should be advised to avoid alcohol while being treated with Symbyax.
To treat bipolar disorder with Symbyax, it is important for patients to take this medication exactly as prescribed even after mood symptoms improve. Patients should also be advised not to adjust their dosing regimen or discontinue treatment with Symbyax without the supervision of their health care provider.

Q: What condition is Prozac used for? Is it used in weight reduction? Is it safe? What are the side effects?

A: Prozac (fluoxetine) is a medication that is used to treat depression, panic disorder, obsessive compulsive disorder (OCD), depression associated with bipolar disorder, as well as other conditions. It is in the class of medications called selective serotonin reuptake inhibitors (SSRIs) and works by bringing a balance to serotonin in the brain that may be the cause of symptoms. The prescribing information on Prozac lists the following as the most common side effects associated with the medication: insomnia, nausea, diarrhea, headache, loss of appetite, drowsiness, anxiety, tremor, dry mouth, decreased sex drive, yawning, indigestion, dizziness and sweating. Prozac is not approved by the U.S. Food and Drug Administration (FDA) for weight loss. Weight loss appears to be a side effect that occurs in up to 2 percent of patients taking Prozac. It is not entirely clear why this medication causes weight loss, although it is generally a small amount. It may be due to the side effects of loss of appetite, diarrhea and nausea that may contribute to the weight loss. Lori Poulin, PharmD

Q: My doctor recently told me to try to increase my 20 mg of Prozac to 40 mg. I tried it, and it made me exhausted during the day and woke me up in the middle of the night. What do you recommend?

A: Prozac (fluoextine) belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). Prozac affects the chemicals in the brain that become unbalanced and cause depression, anxiety, and obsessive compulsive symptoms. Common side effects of Prozac include dry mouth, drowsiness, nausea, and weight changes. Other side effects of Prozac include gas, sleep problems, and loss of appetite. Prozac may also cause insomnia. It is important to consult with your health care provider regarding the symptoms that you are experiencing. Prozac may be taken with or without food and at anytime of the day. It may take at least 4 to 6 weeks for the medication to start working. Do not stop taking the Prozac abruptly without first talking to the doctor because this could cause unwanted side effects. This is not a complete list of the side effects associated with Prozac. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Kimberly Hotz, PharmD

Q: Is it possible to become tolerant to the effects of Prozac?

A: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, panic disorder and premenstrual dysphoric disorder. The most common side effects with Prozac include abnormal dreams, abnormal ejaculation, anorexia, anxiety, asthenia (weakness), diarrhea, dry mouth, dyspepsia, flu syndrome, impotence, insomnia, libido decreased, nausea, nervousness, pharyngitis, rash, sinusitis, somnolence, sweating, tremor, vasodilatation, and yawn. With antidepressants, it is possible to have a worsening of symptoms. Contact your doctor right away if you have any new or worsening symptoms of depression. You should also call your doctor if you are experiencing mood or behavior changes, anxiety or panic attacks, sleep problems, impulsivity, irritability, agitation, hostility, aggression, restlessness, hyperactivity, or if you are having thoughts of suicide or hurting yourself. Worsening of symptoms may be more likely to occur during the first few months of therapy and during dosage changes (either increasing or decreasing doses). Do not change the amount of medication you take without talking to your doctor first. Sarah Lewis, PharmD

Q: Does Prozac cause problems with eyesight?

A: Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Prozac is approved, by the U.S. Food and Drug Administration (FDA), for the treatment of major depressive disorder, depressive episodes associated with bipolar disorder, obsessive-compulsive disorder (OCD), bulimia nervosa, and panic disorder. Some of the most common side effects associated with Prozac include insomnia, headache, weakness, nausea, runny nose, drowsiness, diarrhea, and anorexia. According to the prescribing information for Prozac, abnormal vision and visual field defects were reported as potential side effects occurring in 4 percent and less than 1 percent respectively of patients taking Prozac during clinical trials. Prozac may be taken with or without food. If Prozac causes an upset stomach, it may be helpful to take it with food. Prozac may take several weeks to work after treatment is first started. Prozac will only work if taken daily and exactly as prescribed. Prozac should not be taken on an as needed basis. If Prozac needs to be discontinued, the dose should be slowly tapered down, under the supervision of a health care provider, rather than suddenly stopped to prevent withdrawal symptoms. Patients who are taking Prozac should avoid alcohol use. Do not stop taking your medication without first taking to your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Laura Cable, PharmD

Q: What are the side effects of a Prozac overdose?

A: Prozac (fluoxetine) is prescription medication commonly used to treat depression, generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder. Prozac should be taken regularly, at the same time every day, with or without food. Prozac can be taken at any time during the day, but should be taken around the same time every day. Pick a time that is easy to remember and works well with your schedule and other medications you might be taking. It can take four weeks or longer before you see the benefits of Prozac. Take Prozac exactly as prescribed. Do not stop taking Prozac without first talking to your healthcare provider. Stopping Prozac suddenly could result in withdrawal side effects. Common side effects associated with treatment with Prozac include headache, dry mouth, nausea, diarrhea, sweating, flushing, blurred vision, changes in appetite and sex drive. This is not a complete list of side effects associated with Prozac. If you experience any symptoms that are unusual or bothersome, contact your healthcare provider. Too much Prozac can cause a life-threatening condition known as serotonin syndrome. Signs and symptoms of serotonin syndrome may include agitation, restlessness, confusion, rapid heart rate, dilated pupils, loss of muscle coordination, heavy sweating, diarrhea, headache, shivering, and goose bumps. Contact your doctor immediately if you have any of these serious symptoms of serotonin syndrome or think you have taken a Prozac overdose. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Jennifer Carey, PharmD

Q: I stopped taking Prozac but continued with Wellbutrin. I am dizzy a lot since this change. Is it connected?

A: Prozac (fluoxetine) is an antidepressant which belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs). Prozac is used for the treatment of depression, obsessive-compulsive disorder (OCD), certain eating disorders, and panic attacks. Prozac helps treat depression by raising the amount of serotonin, a natural substance in the brain, that assists in maintaining mental balance. Prozac is usually taken once daily. Take Prozac at around the same time every day. Follow the directions on your prescription label carefully, and take Prozac exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Prozac usually takes about four to five weeks, or maybe longer, before you feel the full benefit of this drug. Continue to take Prozac even if you feel better. Do not stop taking Prozac without talking to your doctor first. If you suddenly stop taking Prozac, you may experience withdrawal symptoms such as mood changes, irritability, agitation, dizziness, numbness or tingling in the hands or feet, anxiety, confusion, headache, tiredness, and difficulty falling asleep or staying asleep. Since you are experiencing dizziness, it may be due to the withdrawal symptoms. You may have stopped taking your Prozac dose too abruptly. Consult with your doctor about lowering your dose more gradually. Then discuss other treatment options that would benefit your medical condition. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Anissa Lee, RPh

A: Prozac (fluoxetine) is an antidepressant classified as a selective serotonin reuptake inhibitor (SSRI). Prozac is used to treat depression and anxiety. It can take approximately one month to see the full effects of this class of medications. However, there should be some improvement within the first few days of taking it. If you have been taking Prozac for a couple of weeks, and there is no improvement, you may want to ask your doctor to consider treatment with a different antidepressant. If there has been some improvement, your doctor may decide to increase the dose to 40 mg. The maximum dose of Prozac is 80 mg, but most people respond to the medication at lower doses. There are many affordable alternative SSRIs, including Zoloft (sertraline), Paxil (paroxetine), and Celexa (citalopram). They are all available in a generic form. Everyone responds differently to medications. With treatment with SSRIs, one medication may work well for one person, but not be optimal for someone else. It takes some time, but it is a matter of finding the right fit for your specific situation. Once you have been on an SSRI for an extended period of time, you should not stop taking it all of a sudden, as it can bring on extreme depression and anxiety. The medications should be tapered down when stopping, especially at high doses. If your doctor changes you to a different medication, there may be a cross-taper (coming down on one medication, while going up in dose on the new medication. There are also other types of antidepressants that can be used if treatment with an SSRI is not right for you. It is important to work with your doctor to find the right medication at the right dose for you. It is extremely important not to increase your current dose dose without the approval from your doctor. For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Patti Brown, PharmD

Q: Can Prozac cause lymphoma?

A: There was no mention in the prescribing information in regards to an increased risk of lymphoma caused by treatment with Prozac (fluoxetine). According to the medical literature, it appears Prozac is being studied as having a role in the treatment of Burkitt

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